The President’s proposal would improve on the Senate bill by toughening oversight of the insurance industry, improving benefits and affordability provisions and closing the Medicare part D doughnut hole. He also added several Republican ideas from the summit such as new proposals to reduce payment errors in Medicare and Medicaid.

In a surprise to many, the RNC called on Groucho Marx to deliver their response.

OK, just kidding. What was striking about the real response from Congressional Republicans was the way they resorted to invective. Away from the Blair House setting—where they could be directly challenged for “having their own facts”—they reverted to much harsher language than they used in the largely civil exchange during the summit. “Job-killing“(Independent analysts say health reform will promote job growth), “budget-busting” (the CBO says that reform will reduce the budget deficit by about $100 billion over 10 years and by $1 trillion over 20 years) “government takeover” (people get a choice of private insurance plans) were some of the greatest hits from the last week in sound bytes. Oh, and of course the ubiquitous “jam” that Jon Stewart spoofed last week (video at 2:20).

Despite the fact that the Senate bill that is remarkably similar to the one that Republican moderates were advancing in the 1990s, today’s Republicans have made it clear (through this RNC fundraising presentation, among other things ) that polarization and fear-mongering are central to their campaign strategy. No wonder no bipartisan health care compromise has been possible.

This fact-resistant extremism could be a factor that helps clear the way for final passage. Another other is a series of highly visible double-digit premium increases that are being proposed across the country, especially in the non-group market. The lack of any insurer accountability has been a stark and timely reminder of the need for change.

Here to there: the New new timetable
Deadlines have come and gone more than once while the health reform debate has dragged on. We now have another schedule for action, albeit a tentative one. The administration is hoping to have a reform vote in the House by March 18, just 11 days from now, and hopes that Senate action will begin prior to the spring Congressional recess, which starts March 29.

The first vote is the hardest
Although the challenges of using budget reconciliation have drawn the most attention from commentators, the hardest step in the process from here on out is the first vote in the House. Although subsequent action will address many of the problems House members have with the Senate bill, the path forward requires the House to vote first for the Senate bill as-is and then vote to fix it—something that many House members have expressed reluctance to do.

Abortion contortion
Probably the House leadership’s biggest stumbling block to assembling a majority is dealing with the abortion issue. In the initial debate in the House, Democrats who opposed choice were joined by Republicans to put in very restrictive language, authored by Congressman Bart Stupak, that many feel will eliminate abortion coverage within the Exchange and may undermine private coverage for abortions in employer-based plans.

According to an analysis by Faith in Public Life,  the language in the Senate already precludes federal funding of abortion.

However, Congressman Stupak has argued that the Senate language is not strong enough, and has declared his intention to vote against the Senate bill, claiming that about 10 other Democrats will join him. Given the very narrow margin of victory in the House, every Democrat beyond Stupak who switches from yes to no because they don’t like the Senate abortion language (or for any other reason) must be offset by switching the vote of someone who voted no the first time to yes the second time.

Facts not worth a hill of beans?
Although it seems his vote is pretty fact-resistant, it appears that Congressman Stupak is misreading the Senate language.

The Senate bill, as best as I can tell, does not allow federal funding of abortions—despite Rep. Stupak’s insistence that it does. And we don’t have to take either Speaker Pelosi’s or the pro-choice community’s word for it. If the Senate allowed federal funding of abortion, then presumably the matter could be addressed in an amendment that would pass through budget reconciliation—an amendment Rep. Stupak would undoubtedly bring.

But there is no such amendment on the table. Why? Because amendments through budget reconciliation must impact the budget, and there is no budgetary implication in the difference between the Nelson and Stupak abortion language. Although there is no public document available, this appears to be the view of CBO.

Remember: the CBO is neither pro nor anti-choice in this debate. They are simply the bean counters. And if they say there are no beans on the table to count that should count for something–if not to Congressman Stupak, then at least to other Congress members who oppose abortion rights as a matter of conscience or religious conviction.

Smooth sailing?
Once a bill does clear the House, the road to reform becomes smoother (not quite seat-belt sign off, but smoother). Although Republicans have threatened to delay the vote in the Senate by filing endless amendments and launching parliamentary challenges, this is as much a psychological game as anything else.

Senate Republicans are trying convince some members on the House side not to take that first vote, playing on the fears of House members who worry that the improvements they’ve agreed to won’t happen and the House will be stuck with the unamended Senate bill. But once the House does vote, the dynamics change. Then the choice is no longer health reform, yes or no, it is health reform as passed by the Senate or health reform with the proposed amendments.

By opposing the amendments to improve the Senate bill, Senate Republicans risk exposing themselves as flip-floppers, voting for policies they previously opposed (such as the special Medicaid funding for Nebraska, and the special excise tax provisions that apply to union-negotiated health benefits) in an attempt to score political points. [I talked about this here last week.]

–Michael Miller, director of strategic policy

photo credit: base10 on flickr

And a year later, it’s still not. Millions can’t afford coverage and millions more can’t afford to get sick on the coverage they have. An industry that has profited by exploiting health circumstances that are often beyond people’s control is flaunting 40 percent rate hikes, reminding us that the only people it answers to today are shareholders.  So the status quo is—well—the same.

But we aren’t where we started. In a year of extensive committee hearings, votes and record hours spent working and reworking bills, Congress has crafted a reform that offers coverage to more than 30 million uninsured, allows more people to buy into the private insurance market, and provides help to those who can’t afford it, a reform that prevents companies from denying coverage or sending families into debt spirals after costly procedures, a reform that improves the way we deliver and pay for care in this country – and that pays for itself completely and sustainably. Both chambers have passed such a bill. We are this close.

There are other things that are different a year on. Since the first convening last March and the summer’s glimmer of bipartisan negotiation, Republicans have made a political calculation that though the bills pay for themselves and would offer much-needed help to many people in their districts, they plan to vote against any and all efforts to pass comprehensive health reform.

And after deliberately standing aside to allow Congress to drive and shape reform – (”I just want to make sure that I don’t get in the way of all of you moving aggressively and rapidly,” President Obama said last March) – the President made it clear Wednesday he’s not standing aside anymore.

“Both during and after last week’s summit, Republicans in Congress insisted that the only acceptable course on health care reform is to start over. But given these honest and substantial differences between the parties about the need to regulate the insurance industry and the need to help millions of middle-class families get insurance, I do not see how another year of negotiations would help. Moreover, the insurance companies aren’t starting over. They are continuing to raise premiums and deny coverage as we speak. For us to start over now could simply lead to delay that could last for another decade or even more. The American people, and the U.S. economy, just can’t wait that long.

“So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on health care reform….and from now until then, I will do everything in my power to make the case for reform.”

Transcript’s end, he stepped away from the mic and said into the applause:  “Let’s get this done.”

–Kate Petersen, Health Policy Hub

I am a speech and language pathologist in a public school system in Arizona. My husband is a retired Public Health Service officer with excellent federal health insurance, and additionally he works full-time as an epidemiologist at a nonprofit organization.  In addition to his federal health benefits, he has  also subscribed to the insurance program offered by his employer so as to cover our daughters as dependents, and to provide primary insurance for me.

My story begins in May 2005 when I was going to an awards dinner. Late on the afternoon of the dinner, after my two-mile exercise walk, I decided that I certainly needed a new frock for the dinner and slipped on sandals to take a brief walk-through of our local outdoor mall.  I succeeded in finding a new dress, but was running very late in getting ready, so I was running across a street in the mall area to get to my car, when the side of my sandal hit a pot hole in the street between brick pavers and I fell.  I continued on my way and went to the dinner, but I had trouble walking and so afterward my husband took me to the emergency room.

I had a non-dislocated fracture of my right ankle.  With a standard course of treatment of casting and non-weight-bearing for six weeks, followed by a walking boot, I gradually returned to full function.  There are no residuals from the fracture.

In 2007, my husband’s business changed insurance companies, and the monthly premium substantially increased.  We considered buying our own policy in order to maintain my coverage and that of my remaining dependent daughter, who was still in college.  My husband got several quotes through an insurance broker who came to the house to ask the ‘few questions’ before collecting the fee and signing us up.

After a lengthy discussion, he told me I would be covered with the exception of my right leg…Not ankle—leg!   I told the agent that there was no follow-up care to my simple fracture, my right leg was uninvolved, and that I was back to hiking and exercising and had been for two years. But he was unswayed in his pronouncement that my right LEG would never be covered.

Needless to say, my husband and I signed up for his company’s group insurance with a higher premium after all, to avoid my leg exclusion.  If the broker agent had only asked the right questions, he would have found out that I had also had a minor surgical procedure on my right index finger earlier that year to remove a cyst – again, without any further treatment. Perhaps then he could have offered me insurance with an entire right SIDE exclusion!

With health care reform,  companies would be barred for denying people with pre-existing conditions coverage – pre-existing conditions that I found out can be specious and exaggerated at the expense of consumers.

Our current system of health insurance coverage is sad and unfair, and I am so grateful to the President, Congress, and all the advocates who are devoting their time and energy to seeking change and justice in the health insurance system so that people get health care benefits they so badly need.

Do you care about changing the health care system? Send your support of health care reform to Congress by signing the petition now (the link works today!)  then sending it on to your family, friends and coworkers.

It’s not about the process
With the summit behind us, the press has returned to obsessing about (and misconstruing) the process by which health reform might move forward. So a few important clarifications are in order.

First, health reform will not pass via reconciliation.  Comprehensive health reform will pass as part of the normal Congressional order via a majority vote in the House of Representatives (more on that vote in a minute); having passed the Senate with a super-majority of 60 votes.  House Republicans will have one last chance to vote on this package and nearly everyone assumes that they will unanimously vote no.

What will also pass–by majority in both the House and Senate–are amendments to that bill.  Those amendments, as outlined by President Obama, would do a number of important things: They would increase and equalize federal Medicaid payments across states, provide low- and moderate-income families with better benefits and/or premium subsidies, close that Part D “doughnut hole,” make the excise tax on high-cost plans fairer, and provide tougher oversight of health insurance premiums.

The question that will come before Congress will be on these amendments.  And here’s what the media should be spending more time on: If Republicans vote no in a block, they will be voting for the “Cornhusker kickback” and against more Medicaid dollars for their states.  They will be voting against improving coverage for seniors with multiple chronic conditions  They will also have to cast a vote that makes it clear whether they stand with regular people or insurers on the issue of premium rate hikes. If we focus on substance over process, then voting for a package of fixes to the Senate bill should be a great vote for supporters of reform, and a tough vote for opponents.

About that vote
The President is expected to offer more specifics on the path forward later this week (probably Wednesday, so check in then for our update). But by now, it seems clear that the Republicans have no interest in tighter regulation of the insurance industry or a major effort to cover the uninsured—and Democrats have no interest in scrapping these elements of reform and starting over.  So we can expect a party-line vote going forward.

There has been a lot of media speculation about whether the votes are there for reform in the Democratic caucus in this scenario. Although it’s impossible to do a real vote count before a package of amendments is agreed on, both branches seem close to having the majorities they need.

Much of the recent speculation has centered on the House, where the challenge will be to find a sweet spot that will satisfy both Blue Dogs and Progressives, avoid too many defections on the abortion issue, and also attract 50 votes in the Senate.

Does that sweet spot exist?  Speaker Pelosi and Majority Leader Hoyer believe the answer is yes, and have reiterated their commitment to passing reform. And the House leadership team has so far shown an uncanny ability to move difficult legislation through the House, so betting against them would be unwise.

The final votes in both chambers may be close, and certainly an all-out effort from the grassroots will be needed, (so sign this petition to send a message in support of comprehensive reform and forward this link to your friends and networks too.)  But as we enter the homestretch of the health care reform debate this year, there is good reason for optimism.

About that status quo
Instead of focusing on the intricacies of Congressional procedure and speculating about the vote count, we need to focus on why reform is necessary.  To that end, the Urban Institute is out with a new issue brief that shows just who loses if health reform doesn’t pass.  The biggest losers (out) are older adults, people with pre-existing conditions (and many of you know firsthand just how big a group insurance companies have made that), small businesses and their employees, low-income households  and young adults. These are the groups for whom the current dysfunctional system works least well, and who will be most at risk of being priced out of coverage if reform doesn’t pass.  But ultimately, the Urban brief points out, improvements in security and stability of coverage, and in the quality of care people get, will benefit everyone.

And that’s what it’s all about.

–Michael Miller, director of strategic policy

As expected, no new consensus emerged yesterday from the seven plus hours of debate between top Congressional Democrats and Republicans and the President about what was wrong with the nation’s health care system and how to fix it. Despite the Democratic mantra that “we’re not that far apart,” what did emerge was greater clarity about exactly where the differences lie and why they cannot be bridged.

First, there is a fundamental difference between the parties on the issue of how to address problems in the health insurance industry. The proposal being advanced by President Obama and Congressional Democrats contains a strong program of insurance reform including:

1. Eliminating pre-existing condition exclusions
2. Setting minimum standards for coverage
3. Requiring insurers to spend at least 80% of the premium dollars they collect on health benefits
4. Prohibiting insurers from charging people more because they are sick (or because they are female) and limiting variation based on age
5. Increasing the ability of state and federal regulators to block excessive and unjustified rate increases

In stark contrast, the proposals advanced by Congressional Republicans would give insurers increased ability to create pools of healthier enrollees, which would lower costs for some but would result in higher premiums for people who are older or sicker.

Anyone? Anyone?

The second major difference is on coverage. According to the Congressional Budget Office, the president’s plan would reduce the number of uninsured by more than 30 million people while the ideas offered by Republicans would insure only around three million (Community Catalyst’s latest paper explores these issues). The President might as well have been the teacher in “Ferris Bueller’s Day Off” given the deafening silence that followed when he asked if there was any way the Republicans could see themselves moving beyond the minimal coverage expansion in their plan.

At the close of the summit, President Obama offered to continue the dialog with Republicans but with the precondition that they rethink their position on these two key issues. House and Senate Republican leaders were quick to decline the invitation, leaving only one path to real reform: Democrats in Congress have to come together to pass a bill by majority vote; the sooner the better.

Moving Right Along

Over the next few days House and Senate leaders will need to consult with their members and with each other to lay out the parliamentary path forward. This “inside baseball” will have to get worked out by the House and Senate leadership and the White House. What matters most is not the sequence, but the outcome.

Keep fighting the good fight

Advocates need to continue to make the case for comprehensive reform. You can help by signing this online petition that is being sponsored by the American Cancer Society/ Cancer Action Network, Community Catalyst, and many other national organizations:
www.healthcarepetition.org/10707_communitycatalyst

-Michael Miller, director of strategic policy

If you’re not already planning to tune in to the President’s health care summit tomorrow, maybe it’s time to reconsider. It will be streamed live here, from 10 AM-4 PM Eastern. Forget Lindsey Vonn and The Office baby special: This is must-see TV.

And if you can’t convince your boss that six hours of C-SPAN is equivalent to 30 minutes for lunch, you can follow the Hub’s twitter feed right from your desktop for a live analysis of what’s going down at Blair House (and maybe a little reform haiku thrown in, too.)

Reaching the Summit

With the release of his plan—really a series of amendments to the Senate-passed Patient Protection and Affordable Care Act (PPACA)—President Obama  is ready to embark on the last leg of the health reform journey. Key changes in the proposal include:

•    Improvements in affordability for low- and moderate-income families in the Exchange. Relative to the Senate bill, most families will either pay less and/or get better benefits.

•    Stronger oversight of health insurance premiums. The proposal would give the HHS Secretary the power to deny or modify excessive premium increases as well as strengthen the ability of state insurance regulators to oversee rates.

•    Phasing out of the coverage gap known as the “doughnut hole” in Medicare Part D, making prescription drugs more affordable for seniors.

•    Increased Medicaid funding for all states (and territories), while eliminating the special funding deal for Nebraska.

•    Equalizing the treatment of union and nonunion health benefits with regard to the excise tax on high-cost plans and also adjusting for age, occupation and gender of workers so that firms with an older and sicker workforce would not be hit as hard.

The President also proposed a series of payment integrity and anti-fraud measures to reduce payment errors in Medicare and Medicaid, drawn largely from Republican proposals. (Full summary of the proposal is available here).

Democratic leaders in the House and Senate have reacted positively to the President’s proposal and seem poised to move forward with reform post-summit, with or without a bipartisan agreement that no one is expecting.

Interestingly, not all of the President’s proposals seem to fit neatly into the rules of budget reconciliation. This suggests that some ideas, such as increasing federal authority over insurance rates, will have to get 60 votes in the Senate in order to survive. However, this is likely a win-win for the Democrats: either the rate regulation provision stays in, or Republicans will have to go on record as siding with insurers against consumers on insurance rates.

Summit Watching Guide

The President has continued to sound the theme of bipartisanship by posting on a website all of the Republican-backed ideas already included in PPACA, and offering to post a Republican proposal or statement of principles side-by-side with the President’s plan.    Republican Congressional leaders, however, aren’t having any of it.

The continued trash-talking of the summit obscures the dirty little not-so-secret that the difference between the Republican and Democratic proposals is not about different means to reach the same end, but entirely different ends.

First, Congressional Republicans by and large reject the premise that all Americans should have guaranteed access to secure affordable health insurance and health care. Secondly, they reject the idea that a stronger public-interest watchdog and a new set of rules is needed to correct fundamental weaknesses in the current health insurance market.These are the central premises of the plans put forward by the President and Congressional Democrats and they are beliefs strongly held by the majority of Americans, notwithstanding their skittishness and disillusionment with the process. (Read Real Reform, Community Catalyst’s analysis of the differences between the approaches put forward by the President and the Republicans here.)

At least one prominent Republican, California Governor Arnold Schwarzenegger, has been willing to call out his party on their stance—calling the demand that the summit start with a blank piece of paper “bogus.” (Now that’s a maverick.)

Because the divide between the two parties is so fundamental, at the summit itself we can expect neither a real attempt to reach bipartisan agreement, nor even a real debate over the merits of various policies.

Instead this will be a battle of competing narratives. The President and Congressional Democrats will to try to focus the discussion on the problems with the status quo and substantive ideas for addressing those problems, while the Republican will try to reinforce their anti-government mantra. (If watching 4 to 6 hours of this kind of sparring is not your idea of fun, you can liven it up by taking a drink every time a Republican says “job-killing big government takeover.”)

Look for a special post-summit Insider Friday!

–Michael Miller, director of strategic policy

The 16 speakers representing faith groups, advocates, consumers, small business, providers, insurers, labor, immigrants, seniors and government called for Congress to move forward on comprehensive reform now. And they asked the Massachusetts delegation especially to support their constituents by voting yes on national reform.

“This is the social justice issue of our lifetime,” said Rabbi Jonah Pesner, leader of the Greater Boston Interfaith Organization. He added that the state’s 2006 health care reform had expanded coverage to hundreds of thousands of individuals, and he hoped for the passage of national reform to help “continue gains in Massachusetts.”

Even while the state’s reforms have helped insure 97 percent of residents, gaps persist, said Amy Whitcomb Slemmer, executive director of Health Care For All, a health advocacy organization (and Community Catalyst’s sister organization). “Too many people still can’t afford coverage. We need to work to close that gap.”

National reform would accomplish that by offering subsidies to 75,000 middle class families to help them afford quality insurance. Reform would also support businesses that now struggle to offer health care to their employees.

“For my business to grow and thrive, we need healthy workers,” said Phil Edmundson, CEO of William Gallagher Associates. “National health reform would provide tax credits to help small businesses offer coverage, allowing them to create jobs and grow our economy. An estimated 70,000 small firms in Massachusetts would benefit, and our economy and health would improve.”

Speaker after speaker emphasized that reform at the national level would not only provide more state residents with affordable care and help fund Massachusetts’ own reform, but it would also improve health care across the country and give those in other states the quality coverage and opportunities that Massachusetts now enjoys.

“The physicians of the Commonwealth not only support the pioneering effort here in Massachusetts, but we know that it’s going to lead to national health reform that will improve the quality and safety of care,” said Dr. Jack Evjy of the Massachusetts Medical Society. “National reform will further expand coverage so that we’re taking care of all of our sick people, and that’s an important thing for America.”

The state’s health secretary, Dr. Judy Ann Bigby, called on the Massachusetts delegation to do what’s best for Massachusetts – and for the country as a whole – by voting for national health care reform, just as they supported the state’s successful reform four years ago.

“Health care is a right, not a commodity,” she said. “It’s time the richest country in the world provided health care to everybody in the United States.”

See videos of the event from Health Care For All: http://www.youtube.com/user/HCFAMA

-Elizabeth Ress, Health Policy Hub

More Summit Surprises

Over the weekend many observers suggested that this indicates either that the House and Senate have reached agreement on a compromise measure, or that the administration is hoping to give them a deadline for reaching an agreement.

Other sources tell us that the administration is working on its own synthesis of the House and Senate bills that Congressional leaders have not yet seen—probably based on the negotiations that were nearly completed prior to the election of Scott Brown in Massachusetts. The administration has also challenged the Republicans to share their own proposals publicly, putting the Republicans in something of a bind.

Smoking Out the Opposition
There’s an old trial lawyers’ maxim that goes, “If you have the facts on your side pound the facts, if you have the law on your side, pound the law, if you have neither on your side, pound the table.”

Republicans seem to be doing a lot of table-pounding in the run up to the summit—claiming that it is not really bipartisan, not inclusive enough, should start with a blank piece of paper, etc.  Pounding the table like this takes attention away from the uncomfortable bind in which they find themselves.

The President wants to focus the summit specifically on ideas to deal with the four problems mentioned above, but Republicans either don’t have much in the way of answers (for example, the House Republican reform package was estimated to cover only 3 million people, compared to over 30 million for the House and Senate Democratic bills) or the answers they have are ones the American people don’t like (such as reducing the deficit by turning Medicare into a voucher program as ranking budget committee member Paul Ryan has proposed ). Refusing to participate would just make them look obstructionist and give the Democrats a chance to showcase their reform plans without rebuttal (In other words, it really is a trap–just like Jon Stewart said. )

Just because you’re paranoid doesn’t mean they’re not out to get you

So to avoid having to actually reveal their position (or lack thereof)to the American people, the Rs strategy is to de-legitimize the summit as much as possible in advance. All this negativity leading up to the summit does not auger well for the chances of a bipartisan breakthrough, but in truth the political leg room has always been fairly limited. Obama is probably sincere about wanting a bipartisan deal, but the actual opportunity to get one is pretty minimal given dynamics in Congress.

On the Republican side, there is no indication of any real interest in moving away from the current strategy of blocking reform, especially since the party feels they have momentum going into the elections. If a strategy is working, why change it? Even in the Senate, where a few Republicans have expressed interest in reform in the past—e.g. Bennett, Snowe, Gregg—it’s hard to imagine anyone breaking ranks at this point. If they did, it is doubtful that anything they would agree to could clear the House, given its  antipathy to the existing Senate bill.

Although the administration has signaled a willingness to consider Republican proposals in areas such as malpractice reform, even this hint is drawing opposition for Democratic-leaning interest groups, which could make its inclusion politically problematic (Not to mention there is little reason to think it would result in substantial cost containment.)

Just because there is really very little opportunity for a new bipartisan synthesis, does not make the summit a waste of time. It gives Democrats a chance to clarify just what is really in their proposals—and why—as well as the opportunity  to disavow certain pieces that have undermined public support (e.g. the special Medicaid deal for Nebraska) and change the narrative with a public that has become increasingly conflicted about reform.

The Divided Self: In which the public disagrees with itself
In a way that earlier debate has not, the summit gives each party a chance to explicate its ideas about reform to the public, much like a presidential debate. And this is good, since the public seems muddled on the issue.

On the one hand, there is less than majority support for the legislation the House and Senate passed. On the other hand, the public continues to support most of the major components in those bills. Inasmuch as the public wants to see a bill, they say they want to see bipartisan legislation. But it’s hard to find major public support for the few Republican health reform idea floating out there, with the exception of malpractice reform.

Most of the public does not believe that major reform will pass, nor believes we can afford to fix the system now. Additionally, trust in government is nearing an historic low, and people are far more likely to list jobs and the economy as the top problem facing the country over health care.

BUT, a substantial majority wants Congress to keep trying. Gotta love group cognitive dissonance.

Further complicating the picture, the partisan divide on whether and how to fix health care is greater than on any other issue.

Democrats remain as committed as ever to health care reform, and are much more likely than Republicans or Independents to say that covering the uninsured is important. Most of the decline in support for reform has come from Republican and Independent voters. For Republicans, this means that the risk of alienating their base outweighs any potential benefits of compromising on health care. And for Democrats, there is no upside to not passing reform but a potentially large price to pay among core supporters for failure.

Given all this, Democrats have every reason to embrace—and Republicans to fear—a major effort to talk about the real issues in the reform debate.

Insurers make the case for reform (well…not intentionally)
Democrats may be looking to the summit to help reestablish a rapport with the public on health care, but meanwhile, they’ve been getting some help from an unexpected quarter. Although insurers have spent more than $20 million trying to kill reform, a spate of recent insurance industry news is helping remind the public why reform is necessary.

By far the biggest story has been a proposed 39 percent increase in non-group rates proposed by Anthem Blue Cross of California. According to the company, the reason has not been health care inflation, but an erosion of the health status of the risk pool. In a down economy, healthier people are making the choice to drop insurance, leaving a sicker pool behind.

This type of death spiral and rate shock is precisely what the health insurance reform is designed to prevent. Under immense political pressure, the company has announced a delay in the rate increase, but the damage has already been done. And while the Anthem story has grabbed the headlines, it is far from an isolated phenomenon. Many other companies are raising rates in the non-group market by double digits.

At the same time that the number of enrollees shrinks, insurers are reporting record profits (Here’s the report.) Taken together, the price shocks and enrollment declines accompanied by record profits make about as clear a case for reform as anyone could ask for.

Health reform countdown (T minus 6 weeks and counting)
By now, it’s clear that the debate on health care reform seems to be following Parkinson’s Law (work expands to fill the time available to do it). Congress seems determined to run the clock down to the last possible second.

The clearest indication of a possible timeline going forward has come from Speaker Pelosi’s office. The Speaker has consistently been pushing the need to advance reform via a two-step process that includes passing the Senate bill and adding amendments via reconciliation. Pelosi’s office has also clarified that the House would initiate a reconciliation bill, though the exact order of business after that remains unclear, and that the goal would be to complete, or nearly complete the entire process by the Easter recess. Basically, this gives Congress four weeks after the summit to wrap up work on health care reform–and advocates the same period to rally the public and Congress for reform.

–Michael Miller, director of strategic policy

photo credit: quaelin at flickr

But there’s hard evidence that whatever else Massachusetts voters were saying, they weren’t saying stop national health reform. Despite our convincing case, the national media kept saying the election was a referendum on health care reform. We kept looking at the polls, which said otherwise. So we’re taking the old statistician’s route: Say it again, with numbers.

The Massachusetts special election was not about health reform.

For voters, the economy came first. Seventy-nine percent of voters said their first priority was to “strengthen the economy and create more good jobs.”

And though 82 percent of voters said they knew of Scott Brown’s position to oppose national reform, this was a wash — just as many said this made them more likely to vote for him, as said it made them less likely to vote for him. (No one said Bay Staters were an easy crowd to figure out.)

And perhaps most tellingly, a majority of both overall voters Brown supporters (including Brown himself) supported Massachusetts health reform – a law that has achieved 98 percent health insurance coverage and served as a model for the national bills passed by the House and Senate. That’s powerful stuff: Opposed to many commentators who have the freedom/burden of conjecturing what reform might do, Massachusetts residents are living with the changes reform made and is making everyday – and they’re pleased.

Hungry for more proof? Check out our fact sheet.

–Kate Petersen, Health Policy Hub

photo credit: Wikimedia Commons

So this week we begin to share why we’ve been drinking so much office coffee this past year, and spending more time connecting with the Congressional switchboard than with our families.

The first story is from Ann Rudy, a field coordinator here.

My mom, who is 60, works as a hairdresser in Texas. Her employer does not offer insurance to employees so my mom and her husband, who is self-employed, purchased policies on the individual market.  She has worked since she was 16 and has always been healthy.  Like many without an affordable insurance option, she rolled the dice when she purchased a high-deductible plan.  Unfortunately, she lost.

Several months later, my mother fell. By the end of the day, she was in pain and was having trouble moving one of her legs.  She thought she could ‘walk it off,’ but eventually she went to the ER in pain. She had shattered her hip.  After major surgery and a hospital stay, my mom is now chipping away at her $10,000 credit card bill.

National health reform could prevent this from happening to others, or to my mom again. Small businesses like my mom’s salon would get tax credits for offering insurance to their employees. And if they didn’t offer an affordable insurance option, she would be able to shop for a plan in the insurance Exchange, where companies would be required to make clear what a plan covers and how much it costs. (In Texas and other states, no such requirement exists right now.) My mom might have qualified for new subsidies to help with her premium and out-of-pocket costs. And new rules in the federal bills would set limits on out-of-pocket expenses, so someone who falls sick—or a healthy person who takes a fall—would never be asked to pay $10,000 of her medical costs from her paycheck, or on her credit card.

If you have a story to share about how health care reform matters to you, please email us at hub@communitycatalyst.org.

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